Topics in Geriatrics: Osteoporosis and Exercise Osteoporosis currently affects 200 million people world wide, with 40 million people affected in the United States [1]. Osteoporosis is characterized by a decrease in bone formation, leading to brittle bones that are fragile and more likely to fracture. Exercise has proven to decrease the risk of developing osteoporosis, as well as decrease it’s severity after being diagnosed. Additionally, exercise and balance strategies decrease the risk of falls and fractures in this population.
Learning Objectives:
Educate the reader about osteoporosis and the risk factors.
Educate the reader on how osteoporosis is diagnosed.
Educate the reader on the benefits of exercise with osteoporosis.
Provide evidence for exercise types and duration.
Provide suggestions to manage/prevent osteoporosis.
Provide other resources about management and/or prevention of osteoporosis.
Osteoporosis and the Risk Factors: Osteoporosis is a gradual condition that is usually not identified until a fracture has occurred. Due to the decreased bone density associated with osteoporosis, there is an increased likelihood of fracture that results from every day activities. The areas most at risk for fracture are the vertebrae of the spine, hips and wrists [2]. Risk factors for developing osteoporosis include [1, 3, 4, 5]:
Age >65 years old
Female gender
Postmenopausal women
Caucasian and Asian heritage
Low body weight (BMI < 20)
Smoking
Taking glucocorticosteriods
Diagnosis of rheumatoid arthritis
Long term sedentary lifestyle
Excessive alcohol consumption
Inadequate intake of calcium and vitamin D
Diagnosis of Osteoporosis: The gold standard test used to diagnose osteoporosis is the dual energy X-ray absorptiometry (DXA). The DXA checks the bone mineral density and calculates a T-score and a Z-score, which categorize the degree of bone mineral density loss [6].
T-Score: [7]
T-Score:
Interpretation:
-1 and above
Normal bone density
Between -1 and -2.5
Diagnosed as osteopenia (below normal, and possibly leading to osteoporosis)
-2.5 and below
Likely to have osteoporosis
Z-Score: Represents the number of standard deviations above or below the normal value. A Z-score of -2, or lower, may indicate there are additional reasons, other than aging, that may be causing bone loss [7].
Benefits of Exercise: Weight-bearing exercises, defined as any activity where weight and stress are placed on the bones of the body, are proven to increase bone mineral density and decrease the risk of fracture [1, 8]. Additionally, it has been seen that older adults with osteoporosis also show an increased risk for falls due to decreased balance control and gait performance, as well as an increased fear of falling. When older adults become hesitant of falling, it is often seen that they limit their activities leading to decreased exercise and quality of life [9]. Therefore, balance exercises that increase the person’s limits of stability, improve postural righting reactions and increase confidence will lead to decreased fall and fracture risk.
Exercise types and duration: Bone-loading exercises (jogging with or without a weighted vest and weight lifting)
3-5 times per week
For weight lifting, build up to 8-12 reps of 70-85% of their 1 rep max [6]
Resistance training (focusing on upper and lower extremities and trunk strength)
2 times per week
50 minutes of supervised time
2 sets of 6-8 reps at 75-85% of 1 rep max [10]
Walking, jogging, dancing or hiking
3-5 times per week
Gradually work up to 45 minutes per session [1, 9]
Balance training (while being supervised by a physical therapist)
3 times a week
45 minutes per session
include dual tasking activities [ 11]
Various systems approach
3 times per week
45 minutes per session
Techniques: change base of support to increase the challenge, reaching/leaning in sitting and standing, sensory orientation with eyes open and closed while standing on different surfaces, gait deviations such as changing speeds and direction [9].
Suggestions for managing and preventing osteoporosis:
If risk factors are present, contact your physician to screen for osteoporosis.
Decrease risk factors that are controllable such as [1]:
Eliminate smoking
Exercise regularly
Maintain a healthy diet that is rich in calcium and vitamin D
Make sure to get about 10 minutes of sunlight daily to stimulate vitamin D production
Consult your physician before drastically increasing your physical activity level.
When exercising, include a variety of types such as resistance training, weight-bearing and balance activities [1]
Fall prevention strategies:
Visit a physical therapist to assess your fall risk.
Remove tripping hazards from the home such as clutter, wires that cross the floor and rugs that my roll or cause you to trip.
Ensure that there is proper lighting in the home, especially at nighttime [1].
1.Dolbow D, Gorgey A. Non-Pharmacological Management of Osteoporosis. Clinical Kinesiology. Summer2013 2013;67(2):5-9. 2.Palombaro K, Black J, Buchbinder R, Jette D. Effectiveness of Exercise for Managing Osteoporosis in Women Postmenopause. Physical Therapy, August 2013;93(8):1021-1025. 3.Looker A, Sarafrazi Isfahani N, Fan B, Shepherd J. Trends in osteoporosis and low bone mass in older US adults, 2005-2006 through 2013-2014. Osteoporosis International. June 2017;28(6):1979-1988. 4.Park E, Tran B, Best B, Singh R. Relationships between Known Risk Factors for Osteoporosis and Heel Bone Mineral Density in Asian Populations. California Pharmacist. 2017;64(1):41-48. 5.Amarnath A, Franks P, Fenton J, et al. Underuse and Overuse of Osteoporosis Screening in a Regional Health System: a Retrospective Cohort Study. JGIM: Journal Of General Internal Medicine. December 2015;30(12):1733-1740. 6.Bilek L, Waltman N, Lang M, et al. Protocol for a randomized controlled trial to compare bone-loading exercises with risedronate for preventing bone loss in osteopenic postmenopausal women. BMC Women's Health. August 30, 2016;:1-12. 7. Mayo Clinic: http://www.mayoclinic.org/tests-procedures/bone-density-test/basics/results/prc-20020254 8.Zarowny Y. Osteoporosis: Exercise and safe movement. Canadian Pharmacists Journal (Allen Press Publishing Services Inc.). May 2, 2011;144:S16 9.Halvarsson A, Franzén E, Ståhle A. Balance training with multi-task exercises improves fall-related self-efficacy, gait, balance performance and physical function in older adults with osteoporosis: a randomized controlled trial. Clinical Rehabilitation. April 2015;29(4):365-375. 10.Wilhelm M, Roskovensky G, Emery K, Manno C, Valek K, Cook C. Effect of Resistance Exercises on Function in Older Adults with Osteoporosis or Osteopenia: A Systematic Review. Physiotherapy Canada. October 2012;64(4):386-394. 11.Halvarsson A, Oddsson L, Franzén E, Ståhle A. Long-term effects of a progressive and specific balance-training programme with multi-task exercises for older adults with osteoporosis: a randomized controlled study. Clinical Rehabilitation. November 2016;30(11):1049-1059.
Osteoporosis currently affects 200 million people world wide, with 40 million people affected in the United States [1]. Osteoporosis is characterized by a decrease in bone formation, leading to brittle bones that are fragile and more likely to fracture. Exercise has proven to decrease the risk of developing osteoporosis, as well as decrease it’s severity after being diagnosed. Additionally, exercise and balance strategies decrease the risk of falls and fractures in this population.
Learning Objectives:
Osteoporosis and the Risk Factors:
Osteoporosis is a gradual condition that is usually not identified until a fracture has occurred. Due to the decreased bone density associated with osteoporosis, there is an increased likelihood of fracture that results from every day activities. The areas most at risk for fracture are the vertebrae of the spine, hips and wrists [2]. Risk factors for developing osteoporosis include [1, 3, 4, 5]:
Diagnosis of Osteoporosis:
The gold standard test used to diagnose osteoporosis is the dual energy X-ray absorptiometry (DXA). The DXA checks the bone mineral density and calculates a T-score and a Z-score, which categorize the degree of bone mineral density loss [6].
T-Score: [7]
Z-Score: Represents the number of standard deviations above or below the normal value. A Z-score of -2, or lower, may indicate there are additional reasons,
other than aging, that may be causing bone loss [7].
Benefits of Exercise:
Weight-bearing exercises, defined as any activity where weight and stress are placed on the bones of the body, are proven to increase bone mineral density and decrease the risk of fracture [1, 8]. Additionally, it has been seen that older adults with osteoporosis also show an increased risk for falls due to decreased balance control and gait performance, as well as an increased fear of falling. When older adults become hesitant of falling, it is often seen that they limit their activities leading to decreased exercise and quality of life [9]. Therefore, balance exercises that increase the person’s limits of stability, improve postural righting reactions and increase confidence will lead to decreased fall and fracture risk.
Exercise types and duration:
Bone-loading exercises (jogging with or without a weighted vest and weight lifting)
- 3-5 times per week
- For weight lifting, build up to 8-12 reps of 70-85% of their 1 rep max [6]
Resistance training (focusing on upper and lower extremities and trunk strength)- 2 times per week
- 50 minutes of supervised time
- 2 sets of 6-8 reps at 75-85% of 1 rep max [10]
Walking, jogging, dancing or hiking- 3-5 times per week
- Gradually work up to 45 minutes per session [1, 9]
Balance training (while being supervised by a physical therapist)- 3 times a week
- 45 minutes per session
- include dual tasking activities [ 11]
Various systems approachSuggestions for managing and preventing osteoporosis:
Additional resources:
References:
1. Dolbow D, Gorgey A. Non-Pharmacological Management of Osteoporosis. Clinical Kinesiology. Summer2013 2013;67(2):5-9.
2. Palombaro K, Black J, Buchbinder R, Jette D. Effectiveness of Exercise for Managing Osteoporosis in Women Postmenopause. Physical Therapy, August 2013;93(8):1021-1025.
3. Looker A, Sarafrazi Isfahani N, Fan B, Shepherd J. Trends in osteoporosis and low bone mass in older US adults, 2005-2006 through 2013-2014. Osteoporosis International. June 2017;28(6):1979-1988.
4. Park E, Tran B, Best B, Singh R. Relationships between Known Risk Factors for Osteoporosis and Heel Bone Mineral Density in Asian Populations. California Pharmacist. 2017;64(1):41-48.
5. Amarnath A, Franks P, Fenton J, et al. Underuse and Overuse of Osteoporosis Screening in a Regional Health System: a Retrospective Cohort Study. JGIM: Journal Of General Internal Medicine. December 2015;30(12):1733-1740.
6. Bilek L, Waltman N, Lang M, et al. Protocol for a randomized controlled trial to compare bone-loading exercises with risedronate for preventing bone loss in osteopenic postmenopausal women. BMC Women's Health. August 30, 2016;:1-12.
7. Mayo Clinic: http://www.mayoclinic.org/tests-procedures/bone-density-test/basics/results/prc-20020254
8. Zarowny Y. Osteoporosis: Exercise and safe movement. Canadian Pharmacists Journal (Allen Press Publishing Services Inc.). May 2, 2011;144:S16
9. Halvarsson A, Franzén E, Ståhle A. Balance training with multi-task exercises improves fall-related self-efficacy, gait, balance performance and physical function in older adults with osteoporosis: a randomized controlled trial. Clinical Rehabilitation. April 2015;29(4):365-375.
10. Wilhelm M, Roskovensky G, Emery K, Manno C, Valek K, Cook C. Effect of Resistance Exercises on Function in Older Adults with Osteoporosis or Osteopenia: A Systematic Review. Physiotherapy Canada. October 2012;64(4):386-394.
11. Halvarsson A, Oddsson L, Franzén E, Ståhle A. Long-term effects of a progressive and specific balance-training programme with multi-task exercises for older adults with osteoporosis: a randomized controlled study. Clinical Rehabilitation. November 2016;30(11):1049-1059.